Site Mobile Navigation

KABUL — I’ve learned that Afghans are prone to pragmatism when it comes to what we Westerners refer to as disability. Despite what you might think, our obsession with identity politics doesn’t play very well in Afghanistan, at least about this it doesn’t.

In the West, stricken, lame, crippled, retarded, handicapped, challenged, and disabled all have been part of a struggle to find acceptable terminology. Here, in Afghanistan, despite what the constitution might say, you can contribute or you can’t. And trying to survive in the can’t category means profound vulnerability in a pragmatic place such as this.

You’d be hard pressed to find anyone anywhere in the country with a formal diagnosis of cerebral palsy. Forget developmental delay. In the end, functionality trumps any labels, especially in the vast rural regions of the country. People are simply described as having “a problem.” After all, someone has to pull the cart in the bazaar. The floors will need to be swept by someone. Rice grains must get sorted. If you can perform a functional contribution, then you don’t need a limiting label.

I personally know several one-armed machinists working happily here in Kabul. Over time I’ve become acquainted with deaf stone workers and brick-carriers, limping ditch-diggers, slow but capable cook’s assistants, and various others in wage-worthy and highly-functional roles across Afghanistan, supporting their families and contributing to the food on the table. And, yes, there are tragic examples of disabled people hidden by their relatives. But there are far far more instances of Afghan families that expect participation and productivity, regardless of a limp, an amputation, poor vision, slurred speech, or a noticeably dulled intellect.

On several occasions after I arrived in Bamiyan I saw cases of easily recognized disability in the pediatric ward of the hospital I was managing. On morning rounds we would follow the customary bed-by-bed practice of presenting cases: “Here is Ali, probably around nine years old. He was admitted yesterday with acute respiratory illness, and since this morning is responding well to intravenous antibiotics. [To his Mother] How is Ali feeling today?”

She reported with relief that he was feeling better, thanked the doctors, and asked when they could go back to their farm where there was too much work to do. “Soon” she was told. End of encounter and the doctors moved on to the next bed. Yet Ali’s other issues beyond the pneumonia — his lack of speech and an obviously-withered right arm and hand — were not even mentioned in the presentation of his case. I thumbed through the medical record and saw nothing indicating these easily observed problems. They seemed noteworthy observations to me.

After rounds, in talking with one of the doctors, my questions about Ali’s apparent disabilities came as a surprise: “Why should we bring attention about this to the boy’s mother? What would be the point?” Clearly, his mother knew the extent of his deficits and would have been coping with them up to this moment. By labeling and pathologizing his challenges, I was reminded, we would be drawing negative attention to an otherwise functional and probably productive child’s prospects. He would work and eventually have a wife and several sons if it was Allah’s will. In other words: Don’t go there. What would be the point? How would it help him or his family to call this cerebral palsy?

If your first thought is that diagnosing a disability and properly assessing it ensures little Ali will get effective rehabilitation, I would have to point out that we’re talking about Afghanistan. In reality, the entire country of 30 million people has fewer than 300 properly-trained physical therapists. There are no Afghan occupational therapists. In 2009, almost half of the country’s trained physical therapists were working in other professions.

Precious few are working as therapists outside of Kabul. But based on the two years I’ve lived here, I can confidently say this little boy would have roughly the same chances at social inclusion in his community as the other children with congenital, birth-related, or trauma- and illness-related injuries: Fairly good odds — if he has any functional capacity to contribute.

Will he be pushed to attend formal schooling and excel in academics? Probably not, but neither would any of his siblings or peers in most of Afghanistan, at least not past the first few primary grades. In the hard-scrabble world of rural farmers and shepherds the value of a formal education is questionable for many families. There are often several mouths to feed. Certainly some families connect education with economic prospects and prosperity, but schools in remote communities can be a bit of a hard-sell.

So, what to do? Does social inclusion really have to depend on the ability to make an economic contribution? If it does, and it seems to, should that then drive efforts to bolster the dignity of people with different kinds of disabilities? Does it boil down to making sure they can get jobs? Vulnerable people are part of under-developed communities across Afghanistan. Bringing the most-at-risk into a position where they can more fully-participate has to be balanced with the reality that huge segments of the population are similarly struggling to get-by, even without the added burden of a disabling condition.

Earning anything at all or helping to sustain a household may be enough contribution given the overall level of unmet need. Is that somehow selling short the potential of people with disabilities here? I’m not sure. Is sweeping the floor or pulling a cart in the bazaar actually less valuable than being a teacher or an accountant? Strictly in terms of wages, yes, of course. But the place of people with disabilities in this society is more complicated than a one-dimensional measure of economic viability.

I’m afraid that imposing romanticized Western values (and labels and expectations) onto experience here would be far more detrimental than beneficial. At the same time, my sensitivities about vulnerable people in desperate situations prevent me from giving up on this one. I’m hopeful that some version of an independent living center, a locally-appropriate version developed by Afghans with disabilities, will go some way to ensure self-empowerment and social inclusion, bolster demands for the removal of physical barriers, and ultimately influence what constitutes a contribution. All are linked to individuals demanding opportunities to be functional contributors to their families and society. And what a huge leap for little Ali that will be, whether he ends up sweeping his home or teaching advanced accounting.

What's Next

About

At War is a reported blog from Afghanistan, Pakistan, Iraq and other conflicts in the post-9/11 era. The New York Times's award-winning team provides insight — and answers questions — about combatants on the faultlines, and civilians caught in the middle.

Behind the Curtain

Remembering a Fallen Colleague

The New York Times has established an education fund for the children of Sultan Munadi, an Afghan journalist who was slain in Afghanistan in 2009. Learn more about him and how you can contribute here. »

Archive

Recent Posts

Marine Corps Captain Calum Rammhe, a longtime marathon runner, ran seven marathons on seven continents in seven days to raise money for a charity that supports wounded Marines and their families. It also let him reflect on why running is more than a hobby for him. Read more…